Cole described fiscal year 2016 as “the worst year in her career” as Pawnee’s administrator. Pawnee paid $12.1 million in expenses and ended the year with a $491,000 deficit. The health care provider has tried to make cuts from within, Cole said.

“We’ve been pedaling as fast as we could to stay ahead,” Cole said. “This last year, the impact of those cuts caught up with us. We are facing a deficit of similar proportion this year.”

Cuts to state and federal programs have devastated the non-profit group’s operations. The issue has been compounded the uncertainty of Medicare and Medicaid programs. Pawnee has forgiven a substantial amount of debt in order to continue serving the ten counties across northeast and north central Kansas.

“All these issues — all these cuts — they’ve created a dynamic that’s put us on an unsustainable road.”

In her annual report and budget request, Cole said Pawnee served 516 patients from Pawnee County in 2016. It made up 7.3% of all patients seen that year. When crafting her budget proposal, Cole multiplied the $491,000 by 7.3% in order to come up with her proposal that the county pay $35,847 for services.

Pottawatomie trails the other nine counties in the health system, paying $147.13 per patient each year. Other counties in Pawnee Mental Health Service’s area of operation are paying an average of $158 patient.

Cole noted the county pays $2.58 per capita for mental health care, while the state average per capita is $7.44. Funding would increase by 129% if commissioners desired to meet the state average.

Cole said Pawnee Mental Health Services is not looking to increase its services — only to break even.

“Breaking even is not sustainable,” Cole said. “Breaking even is just getting to not losing money.”